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Become a member

Joining the CMV group helps you to keep up to date with what we are doing at CMV Action . It also gives us vital information about the extent of CMV and allows us to put parents in touch for support.
The information will be kept confidentially and will not be shared with anyone without your permission.

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Contact information

First name *

Middle name

Last name *

Phone number

Mobile

What is your interest *

N/A

Parent or carer

Professional

Other family member

Other

Child details

Childs Firstname

Childs Lastname

Gender

Childs DOB

Date

E.g., 15/08/2018

Describe Problems

Please can you describe any problems that your child experienced at birth/diagnosis as a result of CMV (e.g. symptomatic/asymptomatic, jaundice, enlarged liver/spleen, rash, low birthweight, calcifications etc.)

Any other information eg. antivirals or outcome

Please can you describe any problems that your child experiences now as a result of CMV (e.g. hearing & sight, communication, physical issues, feeding, sleep, learning difficulties, mental health)

Address

Country

Address 1

Address 2

Town/City

County

Postcode

Partner/spouse Name

Listed as contact *

Would you be willing to be listed as a contact for other members who need support?*

Details Passed On *

Would you be willing to have your contact details passed to any professionals
undertaking research relating to CMV?